How To Tell You Work At A South African Public Hospital

Standard

South African students are trained at public hospitals – which provides for a lot of frustration, but is also the only reason we get as much experience as we do.

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1. A standard question you ask patients is, “Have you visited a traditional healer lately?”

…You know that if they answer yes, it may have major ramifications for your treatment plan.

…You know that if they answer no, they’re probably lying.

2. You have done emergency consultations in hallways because Admissions was overflowing.

3. You have performed at least one procedure that was beyond your scope of practice at the time, due to a lack of staff or resources.

4. Your patients regularly feign new symptoms so that they can have another night of warmth and free food

…But other patients demand discharge to go “home” – the homeless shelter.

5. You have treated several prisoners

…Prisoner patients are sent to hospital with frail old men has prison guards…

…And upon their entrance to the hospital, the guards undo their handcuffs. So safe.

6. You have special code-words for certain diagnoses (such as RVD for HIV) because of the lack of privacy in an overcrowded hospital.

7. The resuscitation area in Trauma is protected by guards and gates (because healthcare workers are not exempt from being threatened by criminals).

8. Your biggest fear at work is a needle stick injury.

… and you know the latest post-exposure regimen better than you know STD syndromic management.

…But if you have a needle stick injury, you know that you will have to pay for your own PEP.

9. Foreign doctors or medical students come to your hospital to learn about the “rare” diseases you see every day.

10. You know what a phlebotomist is, but you have never seen one.

11. You believe that resus teams are a myth. Your patient codes, you resuscitate them. You’re in a room where a patient codes, you help. Done.

12. You have been asked to refrain from using gloves for blood draws and other procedures, in order to save money.

13. You have worked in a flooded ward.

14. You have heard of hospitals with air conditioning, but doubt their existence.

15. You see TB patients every day, no matter which department you work in…

… yet there are rarely N-95 masks available.

16. You have had patients stay in hospital for an extra week because they did not have transport to get home.

17. You have had patients stay in hospital for several extra weeks while waiting for their socioeconomic circumstances to be managed.

18. Your tourniquet does not belong to you – you once had your own, which disappeared (was stolen) on duty. You found another.

19. You bring your own ophthalmoscope to hospital, the risk of it being stolen preferable to using the hospital’s shabby (or non-existent) equipment.

20. Your hospital has funds for RFID for babies, but not for CCTV in the rest of the hospital.

21. You have ordered blood for a patient, only to be told that the “machine is broken”.

Making an eyelid retractor from a paperclip, by Dr Nicola Freeman

Making an eyelid retractor from a paperclip, by Dr Nicola Freeman

22. You have learned to innovate…

For example making an eyelid retractor from a paperclip.

Litmus paper to test pH? No, urinary dipsticks will do.

You have catheterized a baby with an infant nasogastric tube, because infant catheters are too expensive.

23. One of the scariest parts of your day is taking the sketchy elevators.

24. Despite all these, you are grateful that working in a public hospital has taught you how to treat maximally with limited resources. You believe in evidence-based medicine, and you are grateful that you can practice it without fearing for your livelihood.

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162 thoughts on “How To Tell You Work At A South African Public Hospital

  1. Is this where you want to spend your career? Or would you prefer a different area/country? I teach in a low-socioeconomic area and sometimes wonder what “the other side” would be like and figure while it would come with more supplies, pushy parents would also be present.

    • Sigh, that’s such a good question but I’m not sure I have a satisfactory answer. It’s a huge internal debate.
      I hate not having the resources to do my (future) job properly, and I hate fearing for my life when I’m on call in the trauma unit, and I hate that our government seemingly couldn’t give two craps about the whole situation.
      But I worry I would be bored in private practice, that I would be unchallenged. I don’t want to feel pressured to do a procedure on a patient before it is indicated – for example, in state we only perform cataract ops once the cataract causes visual disturbances, while in private they do them as soon as the tiniest sliver of cataract appears – which is not indicated by Evidence-Based Medicine, at ALL.
      But I would love to have patients who give a damn about their health and their wellness, and I see so little of that. I tire of crying for malnourished children and people who refuse to take their ARVs.
      So, I am not sure. I will probably end up taking the best of both, in terms of having a private practice but working in a public hospital a few hours a week.
      As for working in another country, that’s all dependent on how the economy and safety of my country progresses or regresses, but if I manage to do my Royal College exams, I will probably spend a few years as a foreign locum for financial/life-experience reasons. But that will be temporary and I’ll always return.

  2. Wow, I loved reading this list! I’m a first year nursing student in NY and will start clinical in the hospital in a few weeks. This is such a fascinating peek into your life and work! It’s also a tad shocking…being asked to not use gloves at times? And improvising when the proper equipment isn’t available..wow. When I get my B.S.N. I hope to travel and work in all kinds of different hospitals overseas.
    (That code word for privacy thing is a great idea and I’d never heard of it!)
    Stopped by from SITS :)

    • Thanks for the visit, Christy! Good luck with your clinicals. I think it will be a great experience for you to travel and work in different countries, and it will be a real service to those countries as well. Great to meet you!

  3. So interesting and such an eye opener . Especially since I am a medical student in India some points resonated with me(for eg prisoners being brought to the hospitals and the lack of adequate equipment). At the same time this post made me a tad more grateful , because I realised that we are actually much more comfortably off …no one restricts our gloves usage and we definitely dont have to innovate in case of instruments !

    • Nice to meet you, Charoo! I was in India earlier this year and I have a few medical student friends there too. Awesome country, and a lot of similarities to South Africa, and there is a lot we can learn from each other. Not having to deal with restricted resources is so wonderful! Though I know some clinics like in Kolkata do have issues like that sometimes (maybe they’re charity clinics though, I don’t know).
      I definitely want to go back to India sometime, maybe for a medical elective or just some traveling.
      I’d love to hear more about your experiences in med school :)

  4. Quite possible there are such clinics in remote areas ..our college is associated with the govt hospital ..I live in gujarat. It would be great if you visit these parts when you come next time :)
    Never visited south africa myself , whatever little I know I have learnt from your wonderful posts!

  5. Wow. That sounds incredibly tough. Very impressed because you seem to be managing yourself quite well though!

    Also makes me slightly wary about my elective, but very keen for the experience. Will certainly be eye-opening. Any tips? Can’t wait.

    • Thanks, Ash. You don’t have to worry, you’ll be just fine. Everyone will look out for you, as the foreigner :P
      I guess the best advice I have is to keep your eyes open and don’t forget to think about every action before doing it. And if you worry, ask one of the local students or the doctor in charge.

  6. Great post! Best of luck to you!

    Most of these apply at the public hospital where we train as well — in a major city in the US. Never been asked not to use gloves though — that’s rough

    • Thanks, Little Red! I’ve heard there are some tough hospitals in the States too. The gloves thing – yeah. Controversial. A lot of docs do without gloves because they’re so good at drawing blood that they don’t spill a drop. But it’s not acceptable to expect it of someone else, I think.

  7. Hmm…my first clue would have been that I was in South Africa, but if I ever wake up in a strange hospital I’ll be sure to check for these signs.

    But on a more serious note, it’s good that you’ve been able to take joy in what you do, despite the dangers. I’m not sure I would be able to handle the stress. I know it’s hard not getting the financial support your hospital needs. And it’s even harder to deal with people who…just don’t care. Here’s my earnest hope that things get better where you are.

  8. Hey fellow South African :) And even though I am not a medical student, I agree with every single one of your statements made above. I am lucky enough to be on medical aid now, but when I was pregnant I wasn’t, and I had to have 9 months of a government hospital. When my daughter was born, I made a plan and got medical aid, as I refused to have her go through even an ounce of what I had to go through. My sister is in and out of government hospitals with various ailments (she had her gallbladder removed last week incidentally) as she can’t afford medical aid, but it is R3000 that I happily part with every month.

    Props to you to sticking it out, and for being an entrepreneur re: your eyelid thing-a-ma-bob :)

    • Aah, the medical aid debacle – I’m sorry you had a bad experience at public hospitals. It makes me so mad that some healthcare workers think they can treat people with indignity just because they don’t have medical aid. I actually would go to public hospitals were it not for the rude staff. And the long waiting times, I don’t really have a lot of patience when I’m sick. Good luck to your sister with her recovery, I hope she’ll feel better soon. I love meeting fellow S’Affer bloggers! Thanks for stopping by!

  9. Reblogged this on wannabepoet and commented:
    For all of my followers, friends and occasional readers, this is just a glimpse of what an ordinary South African person experiences on a daily basis with regards to our national healthcare.

    It is an eye-opener, helped down with a decent dose of humour :)

  10. Having worked in the field of HIV in SA for many years I can really appreciate what you must be going through. I wanted to say thank you for being there – in that hospital – we need more of you. I have been out of the field for a while now – is sleep deprivation still so bad for student docs in the provincial hospitals? One of my memories is of walking into casualty at Hillbrow hospital to deliver blood and there were patients with urgent stickers on their foreheads!

    • So nice to hear from you, and to meet you. Yes, sleep deprivation is still very bad, but with some rotations worse than others. I’ve had a reasonably restful four weeks.
      I have never seen a patient with an urgent sticker on their forehead – I think that is striking and funny and sad and innovative all in one! I’m sure that Hillbrow hospital is far scarier than where I am – so kudos to you!

    • Thanks for reblogging; actually, all our patients aren’t black. Our patient population is pretty diverse right now. With the economy crashing, a lot of South Africans of different races have become dependent on public healthcare. An equaliser, I suppose. We also have a lot of refugees. Poses some real challenges regarding communication, but always good to learn something new. I have a friend involved in raising funds for organisations working to end human trafficking. Really an important job, thanks for your contribution to the good fight!

  11. I love comments too so here’s one for you. I think you should stay in a public hospital cos these patients really need you. They won’t show it and prob don’t even realise the conditions you work under. The rich will always be well looked after. This is where you really will make a difference and on your deathbed you can comfort yourself that you have lived a worthwhile life.

    • That’s pretty much the pep talk I need in a nutshell. Thanks, Cho. It is a lot more satisfying helping the poor than helping the rich. I’ll probably stay, or at least work half-public half-private. Great to meet you :)

      • likewise we only have the one life sorry i dont really believe in reincarnation and life after death what we see is what we’ve got for sure for now so you may as well do the max good and leave some trace of you behind. make a difference, corny but true.

        still haven’t told me why your surname is chen? if it is impudent of me to ask then i m sorry.

  12. There are some things you write here that are just shocking to me, yet there are others that I completely understand. There are some parts of medicine that we all share and others that some of us are lucky to have. Despite our same career choices, it’s amazing to see that we almost work in completely different worlds.

    • Hence why I love meeting foreign students when they do their electives here – and the blogosphere, for that matter. We can learn so much from each other. I’m a little over-excited globalist sometimes, but what the hey ;)

  13. Having known several people who’ve gone through medical training in SA I can sympathise. The hospital in my town even lost its training status last year due to lack of qualified personnel, meaning there are even fewer people to take care of the patients. At least you seem to be staying positive about it all.

    • WOW. I never realised there were hospitals losing their training status. That really is a big problem, we have a shortage of training hospitals already. It is hard to stay positive sometimes, but I find blogging really helps – because sometimes when you put a bunch of med students and HCWs together, all we do is complain ;)

  14. You guys (and girls) are the true heros in our country at the moment- without your help a LOT of people would die… so thanks so much for the long hours and the bad working conditions and all the red tape- you really make a difference!

  15. As a South African, I can relate to all that you’re referring to, even though I’m not in the field of medicine. I loved that you say, that if you would leave our country, you will return….Our country needs more people / doctors like you.

  16. Pingback: Hi, again :) | Delicate Authenticity

  17. What a well written, informative post. We live near a teaching hospital in Durban and have hosted foreign students who have told us the stories of the “rare” diseases they are so excited to treat. I applaud you for sticking with it. I lived overseas for almost 7 years in total, and I only now realise that SA will always be home. I’m glad to finally be settling here. Good luck with your decision about where to carry on with your career.

    • Thank you, Bianca! You’re right: SA will always, always be home. But it’s good to travel and live somewhere else for a bit. That way we never feel like we are here without a choice. By the way, I think it’s great that you host foreign students. I think we learn most when we interact with locals, wherever we travel!

  18. Wow. What an experience. That is tough, and don’t think you *have* to stick it out – remember you will always have choices. Thank you for writing about it, and well done on keeping your sense of humour!

      • Yes, sometimes it is hard to see what our choices are when we are up to our ears in chaos. Enjoy the choices you are making now, learn loads and keep your eyes, heart and mind open!

    • Thanks so much for stopping by, and for sharing that link. I loved it! I would be very scared of drilling into someone’s head to save their lives – that is awesome innovative emergency medicine. What a hero!

  19. So basically, your career is capitalizing on the plight of Africans in South African which was no doubt enhanced by the non-Africans taking over and being there? Is this correct? If such a people can invade a country for greed and personal gain, could they not have shown up to help based on a love for the people, or is it just for exploit? The ultimate help would be to vacate the premises and surrender control back over to the people of the Land!

    • Šahíyena, I am a little perplexed by your comment. And I’m going to try to answer this in the nicest way possible, but your comment is rather ignorant. You may be an informed woman, but this reeks of misinterpretation.

      First, capitalizing? Perhaps you have not read here thoroughly, but I am a medical student. I don’t get paid for what I do. In fact, I PAY to do my job. And yes, eventually I will earn a salary for my work, but in case you missed this, most doctors do. Doctors need to live. People need to live. And if you want to call it that, then I suppose ALL doctors “capitalize” on the plight of ill people – our work is to treat, after all. But no, if I wanted to “capitalize” on the plight of Africans, medicine would not be the career of choice. South African doctors do not make even close to the kind of money as their Western counterparts. I’d have gone into housing, or manufacturing, or God-forbid, POLITICS, if all I cared about was “capitalizing”.

      Also, I resent the implication that all my patients are black. More proof that you really don’t know what is going on in this country. People of ALL races in this country suffer, and our country’s past has hurt us all.

      Your reference to Africans and non-Africans is archaic. My mostly-white skin does not make me less African than the patients I treat. My family has more than a 200 year history here, and there is no other country I love more than South Africa. If “non-Africans” were to leave, they should have left at the most ten years after arriving. Back in the days of the colonies. There are no more non-African South African citizens, and frankly, as a foreigner, you don’t have the experience or the insight to lay such claims.

      I am not even going to address your comment of vacating the land, because based on your own blog that is rather hypocritical.

      I suggest you unstuck yourself from the history books of 200 years ago and start reading multiple sources. Get South African friends, perhaps. Visit, perhaps. Read some Desmond Tutu, some Nelson Mandela, perhaps. As someone who doesn’t know this country (or at least, you don’t present the insight of knowing this country), frankly, you are in no position to make wild accusations or demands.

      P.S: “non-Africans” are no longer in charge here. In case you missed it.

      • P.S: “non-Africans” are no longer in charge here.

        AWESOME!!!

        I do know Non-African residents there who are law enforcement officers and their views of locals (real Africans) are what can be and are expected. Not being in control doesn’t mean hearts and conditions have changed! Also, the snobbish views of those Non-Africans who visit elsewhere when they encounter Africans from the Mother Land living in other countries tell a lot. Non-Africans born in Africa are natives by birth only, not indigenous. As a medical student, irrespective of the race of the patient, pointing out in a negative manner what you have to deal with on a daily basis when it comes to the sickness of others is not a professional thing. On the one hand you seek to help them, on the other hand you degrade them as well! Do the healing and keep your mouth shut, it is what it is. I have never complained about the dying I have held, the sick and diseased I have tended to…that would reveal an inner conflict. History is the foundation of the future of any people…unstuck is not something you do when it comes to your foundation! Ignorance is thinking that the people you once subjugated still wants you there! Not angry with you, just the situation and the way your words hit me. Thanks for reading my Blog! :)

    • Good day:)

      I read your Bio on your Blog and you pride yourself on being a “natural-born American citizen”.

      Then why may the barefootmedicalstudent (and me for that fact) not be a natural born South AFRICAN?

      Please use the same methods of assessment for all people.

      And people of the land is a tricky one. The only original people in SA are the San. They were displaced on the east coast by the Bantu speaking people who migrated down from the North to settle what is now Kwa-Zulu Natal, the Eastern Cape and Mapumalanga.

      West of the Fish river they were displaced by the European settlers.

      Thus if we were to return the land to the people, the Zulus, Xhosas, Sesothos, Vendas, Malay, Indians, Afrikaners, English and basically everyone besides the San should leave.

      This is only to show how a muddled place the world is. Everyone’s ancestors have once lived in one place only to later occupy an other.

      Greetings
      Stephan

      • Stephan I am most positive the word ‘pride” does not appear in my Bio, perhaps your specs are failing you?

        The Indigenous people of the American Nation are the First People, the Native American Indians. I am Cherokee Indian through the loins of my grandfather, therefore I am both a Natural born citizen of the United States of America, as well as indigenous to the soil!

        I am also by bloodline, indigenous to Africa and Ireland!

        After the dividing and scattering of the Nations, the descendants of Ham populated Africa, the location from the Great Sea inland to Jericho, and even a certain area in Europe amongst the Japhetic people.

        God gave to every people their own land for the sake of peace and less destructive activities. Unfortunately, Canaan, the son of Ham decided he wanted to migrate into an area that was given to Shem and his descendants for an inheritance.

        God allowed Canaan to dwell in the land until He brought forth the descendants of Shem out of Egyptian bondage to possess the land; at which time He instructed Shem to utterly destroy the Canaanites, wipe them out and possess the land!

        If a people claim ownership of a land or country, they had better make sure that God gave it to them for an inheritance, because the earth is the Lord’s and the fullness thereof! He gives as he wills blessings and gifts to one or another, but to take by force what He has not given is a foolish and dangerous thing.

        Thanks Stephan for reading my Blog, I most appreciate it! Thank you for your love for my Mother Land as well! :)

      • Your continue to outdo yourself with ignorance.
        You clearly have read maybe one or two biased sources about South Africa, and had the misfortune to encounter one or two racist South Africans (they exist, white and black and everything else). You cannot walk in here spouting rubbish about a country you do not understand.

        You demand that people leave, yet you yourself would not exist today had your ancestors (the African and Irish ones) not been forced to move. You see, I am assuming that your African ancestors were forced here during the transatlantic slave trade and your Irish ancestors during the potato famine, and those assumptions have a risk of being incorrect, but then, you have made the assumption that all white people in South Africa are of pure white lineage, and that all their ancestors came with impure intent.

        What Stephan is saying, by the way, is that if your “demand” of everyone who does not belong here leaving were to be realised, then the black people in South Africa would have to leave, too. The only rightful inhabitants in South Africa would, by your philosophy, be the 90,000 San who are alive today. (A great many South Africans of all races have some San lineage, though.)
        Also, perhaps you do not want to take the Bible quite as literally as that, considering what it says about slavery, women and genocides.

        Your point regarding my so-called unprofessionalism is rubbish. At no point am I complaining about my patients – if you had gone through the trouble of reading this blog, you would see that I care very much for them. I complain about CONDITIONS – the conditions of a hospital in which they have to lay, and in which I have to work. Because those conditions are not FAIR, and they exist because of a corrupt government that has been inefficient in providing to the country the kind of healthcare infrastructure it deserves.

        South Africa is a beautiful country with incredible people who are trying their best to built a bright rainbow future. Fortunately for us, we do not allow ignorant foreigners to delay our progress.

        You are welcome to respond, but please note that I will not be responding to any further comments of yours until you present something that is rational, substantiative and not ignorant. I, frankly, do not have the time to teach you, especially since you have shown yourself to be unwilling to gain insight.

      • Ignorance? The first word in your response here should be You not Your.

        Thank you for your history lesson on the Mother Land of all Africans. Black is a color, not a race! Our hair is black, our skin is brown…your ignorance precedes you.

        As I said, History (past and present) is what it is!

        Your disbelief in the Bible and God is a clear indication of the condition of your heart, where it came from, how you people got there to begin with, and why you won’t leave!

        Thank you for not carrying this out any further. I made a brief comment and I believe my initial response got the most attention, your presence in my Mother Land Country is obviously a touchy matter for you and others.

        I am signing out. I have got to run, Have a Blessed Day, I know I will! :)

      • Good day once again

        Attacking another person’s grammar is often seen as a sign that you have no true arguments.

        Also, in South Africa “Black” and “White” are often interchangeable with the terms “African” and “European”. (Even though we are more brown and pink as you pointed out)

        Thus she was not being ignorant or disrespectful or ill-informed, but merely using the lingua franca of South Africa. You, not being from SOUTH AFRICA would not know this. It is like the British and the Americans. We all speak English, but some say chips and other fries. So please do not attack her because she is using the dialect she grew up with.

        History is what it is. But you seem quite at ease with ignoring large parts of it.

        For example, barefootmedstudent is of Hugenote descent. They are Protestant (oh Christians and not godless heathens!) French who fled from Catholic persecution (oh not a bunch of exploiting Capitalists who wished to swindle the natives!) to South Africa.

        At first (in 1693- one year after the first Hugenotes arrived) they didn’t leave because France was still a hostile place. They don’t leave now, 320 years later, because South Africa has become their home.

        Your immediate attack on her religious status is not a very Christian reaction. Have you already forgotten what Christ said was part of the greatest law? Love thou neighbour. And do tell me, how is barefootmedstudent not loving her neighbour by working in a short-staffed under resourced hospital?

        And you fail to address the question of Africans who settled in South Africa about 2000 years after Noah got off the Ark. I cannot remember anywhere in the Old Testament where South Africa was mentioned (or North America for that fact. From which of the sons of Noah are the Native Americans descended?) When were they “promised” this land? Or are to be eradicated by some divine plague/intervention/war/reality tv show as well?

        Lastly, you claim ownership of three continents by blood. You refer to South Africa as “your Motherland”. Tell me how well you know your Mother. Tell me of the Karoo stars, the Indian Ocean, the mighty peaks of the Drakensberge. Tell me of the blood spilled in Natal, at Kimberly and Pretoria, fighting against colonialist oppression. Tell me of how the great cities arose, of the Gold Rush, of Shaka and Rhodes and Botha. Because I know this country. I was born under the African sun. As were my parents and their parents, and their parents before them. And like them I have no plan of leaving because I want to serve this country and help make it the best it can be.

        Your mother isn’t the woman who birthed you. Any uterus can do that. A mother is the woman who loves you and raises you, who teaches you and sometimes disciplines you. She is the woman you care for, who you want to make proud.

        I do hope the run was refreshing and mind clearing

        Stephan

      • Would that be the same Huguenots (Huge Knots I call them) Dutch or Boers who began to invade the southern region of Africa now called South Africa to overthrow African King Moshesh to take over the land of his people, whom in the beginning, King Moshesh kicked their butts and managed to fight them off?

        But greed prevailed, and oh all in the name of God, because they were so called Christians, right? They eventually did invade and made that kitchen Dutch their new language calling it Afrikaans.

        In the dividing and scattering of the nations, to each group God gave their own distinct land as their inheritance after the flood…Japheth the younger He gave the continent Europe, to Ham the middle son He gave the continent Africa (the whole continent, not part), and to the elder Shem He gave most of the continent Asia, the rest He gave to Japheth because He said He would enlarge Japheth’s borders and he would partake in Shem’s blessing . One continent was primarily uninhabitable, the continent of Australia was later inhabited by Japheth, and the Americas (at least North America), though not specifically mentioned was inhabited over time by the Native Americas believed to be the Lost Tribes of Israel making them the descendants of Shem!

        Obviously you do not know the Word of God, if you did, you would learn the ways of God, His nature, His methods, His ordinances, and His ways of dealing with humanity.

        You can try to explain away evil until you are red in the face, but truth is what it is…

        In the Scramble for Africa and earlier, Europeans violently and vehemently raped a nation and its people, carried them into slavery and changed the course of a culture forever. Europeans destroyed a heritage, mutilated the land, subjugated souls, corrupted their most sacred things and replaced it with their abominable ways! Where was European’s Godly love when they hung slaves, castrated their men, raped their young daughters and wives, tarred them and split them apart with horses, put out their eyes, starved them, forbade them to be educated, gave them no medical attention, and categorized them as property rather than a human soul created by God? Where is the love of Europeans in present day while they continue their hatred and racism?

        If you understood the ordinances and Word of God, you would understand that God has laws that can not be reversed or done away with…one is the Law of Gravity, you understand this right? There is a Law called Jubilee, in God’s appointed time all things will return back unto its rightful owner (rightful in the sight of God, not your sight).

        My dear friend, there cometh a time, ordained of God, when you and all others will relinquish what belongs to another…either by force or by death! For another law of God is “Whatsoever a man sows, that shall he also reap!” If you have coveted what belongs to another man and have taken by force and caused the violent death of another who has done you no harm, then likewise shall these things come upon you!

        God’s love for humanity does not and will not prevent Him from executing the judgment to come. He said the wages of sin is death, He does not forget history, and if you read the Bible you would learn that the atrocity may have been committed in one generation, but God’s judgment falls on a later generation when the people have continued in their ancestors ways.

        Dear heart, SA is a part of the African continent, the continent in its entirety is the Mother Land of all African People after the flood! Despite the fact that you would like to separate it from the rest of Africa and make it to be something else…it is still Africa, that is why the majority population is roughly 80% dark African chocolate and only 9% Caucasoid, but yet the majority poverty lies amongst the Africans and middle-class wealth lies with majority European.

        I won’t even bother to address the birth mother comment, you obviously were adopted. Oh wait, you think you have been adopted by my Mother Land and want to be African as I am? Everybody wants to be African these days and have what Africans have…but God only gave it to one group of people. Our land is blessed, beautiful, rich in resources and wonders, and so is the people…blessed and beautiful!

        I am so sorry that by speaking the truth of history you are so offended. I was offended by what was done to my people! There was no love in the hate inflicted upon my people, but because it was God who brought us through, even though we speak the truth, we do so in love and understand that love does not prevent judgment.

        Move on from this my friend, this is not your Blog. Your argument isn’t with me, your judgments are from the Lord! Get a life and obey the Word of God. I will address this matter no more, it is done! :)

      • You have a very limited knowledge of South African History.

        Moshesh (or rather Moshoeshoe as the proper was the king of the Sothos. Not of Africa. He fought wars against other African Nations. Such as the Zulus.

        And he played the British off against the Afrikaners in the Free State-Basotho war, and in the end turned his country into a British protectorate. Thus a colony.

        And that was in the 1800’s. The Hugenotes, who were refugees, arrived a hundred years before them.

        Being unaware of history you do not know that the Afrikaners left the Cape Colony, which the British annexed after the Napoleonic wars. The reason for their departure was the growing marginalisation by the British rulers.

        So they didn’t go out to overthrow anyone, rather they were searching for a better life away from Imperialist oppression.

        No matter how much you want it, Africa isn’t one big country. It is a continent with many states. They warred with each other before the Europeans arrived and many are still fighting after they left. The Mfecane was responsible for the depopulation of large parts of South Africa allowing the Voortrekkers to move through the future Free State and Transvaal.

        And before the arrival of (european?) Missionaries the tribes of South Africa were ancestor worshipers. And the Native Americans also were not Christians that I know of.

        Thus all these laws and facts you mentioned were inherited from Europe, who’s monks kept the Faith alive during the Dark Age of barbarian invasions.

        Lastly your snide remark towards Afrikaans is uncalled for. The english language is also the bastard child of Anglo-Saxon barbarians, the Celtic natives of Britian and Latin.

        I will rather not try to discuss the theological elements, for a fanatic like you would never be part of a reasonable conversation.

        At least with the historical components there are clear facts one can read up about which are not open to over zelous interpretation such as the Word of God.

    • Oh, thank you, that’s so nice of you!
      I think sainthood is a bit above me. But it’s definitely a characteristic to strive towards.
      Also, thanks about the FP – it’s still a little overwhelming!

  20. I’ve also believe in Evidence Based practice but it seems it would be even more important here where no time or supplies can be wasted if people are to survive.

    • Absolutely – it definitely makes us more efficient with what we have. On a side-note, it may have sounded that I was implying that many healthcare workers in private or in other countries don’t care much for EBM – which I know is not the case. :)

    • “fabulously dysfunctional” — ooooh, I LIKE that! I think it describes the experience perfectly – because I love it, despite the difficulties, and sometimes I worry that I love it BECAUSE of the challenges. (Am I a masochist?) Thank you for stopping by :)

  21. I laughed so much because it’s all so true, I am a physio in a government hospital and can I identify with most of these points.
    On the other hand it’s really quite sad and I hope that things do improve.
    My old hospital once had no crutches or walking frames – not a single one.
    I’ve worked in private practice and it was not enjoyable at all – boring, uninspiring, and we we’re often made to do things that aren’t evidence based. I have also found that patients at government hospitals are a lot more grateful.
    Don’t be too quick to change – although I like your idea of doing a bit of both.
    Thanks for a great post

    • Thank you, Leigh! I can’t imagine having to help a patient mobilise without a walking frame… that’s just ridiculous.
      Thanks for sharing about your stint in private practice. I don’t want to change, but financially (and for my sanity) doing a bit of both might be the best route. But I’ll be in public for at least the next eight years, so we’ll see what happens.
      I hope things can change too. I think it is going to take a concerted effort from all of us, but I do think that it is possible.
      Best of luck in your work!

  22. Great piece!! Kudos to you for your wonderful work. Our country needs true patriots and saints such as you. It’s always refreshing to hear people speak about staying in South Africa to help better the lives of others instead of emigrating to Australia and the like because of the “poor condition” our country is in.

    However on another point, and maybe I should phrase it as a question, bearing in mind that South Africa as a third world country we are doing much better than some of our other compatriots in Africa and abroad, what do you think the government is not doing enough of to make government hospitals a safe and fully functional place of healing?

    Secondly, when you say the government “couldn’t care less” or “doesn’t care”, do you think it’s because they do not prioritise on health in public hospitals or is it a case of allocated funds not trickling down to the provincial hospitals? – because the government pledges most of its finances on Health (and education) every single year.

    Otherwise, as said above. Thank you for your work!

    • Thank you, Mlungisi! I don’t think I’m a saint, but I do love our country, and whenever I travel (which I love) I get terribly home sick. I wouldn’t want to leave.
      Thank you for your questions, I’ll try to answer them as best I can.

      1. I think your assessment that we are doing pretty well as a third world country is fair, and I think it is important for us not to get carried away, expecting our healthcare system to evolve into Japan’s in a second. But what really shocked me was when I read a report about how South Africa fares in terms of healthcare compared to other third world countries. For example, South Africa has a higher gross national income that Eritrea, Vietnam, Cuba or Nepal – yet these countries all have higher life expectancies than us.
      When I visited hospitals in Vietnam and Ghana and Morocco, for example, I never felt unsafe. But I digress: what is the government not doing enough? To be fair, I don’t think that it is completely in the government’s power to change. They can’t snap a finger to end gang wars, for example – but they sure could do more to end it. I always think that our hospitals should have metal detectors, because I don’t want to treat patients when I can see a gun bulging in their side (nevermind that one should not be concealing a firearm). But then again, perhaps in the scheme of things, metal detectors are a low-priority, high-expense item.
      I think that a lot of money is being spent on meetings and policy work, and not enough on improving hospitals. Our hospitals LOOK terrible (bar for a few really nice public hospitals that I’ve seen), and that does not encourage enthusiasm in the patients or the healthcare workers.
      I think it all comes down to fund management. Because for all the money that is plowed into healthcare, I just don’t see its results anywhere. I would love to be able to work in the department for a while so that I could see where it all goes, maybe then I’d be more at peace. But I think that if our economy manages to strengthen, we’ll see health and education improving too.

      2. I recognise that inferring the government doesn’t care about health sounds very pessimistic. I think the government does care about healthcare, and that they are trying, but again, that funds are mismanaged. I’m tired of seeing politicians in nice suits and fancy cars, and then having to know that the best treatments are not available to my patients.
      I think funds definitely aren’t trickling down as they are supposed to. Also, I feel sometimes that the government thinks that people shouldn’t complain because hey, at least they have access to healthcare.
      I think my biggest problem is that the government seemingly doesn’t care about their healthcare workers and students. For example, there are never any specialised TB masks available in hospital, which means that students and professionals are constantly exposed to TB. It has reached a point where we are purchasing our own masks – and the N95 masks sell for R15 a shot. Bearing in mind that students aren’t paid for their work, that’s basically our lunch-money buying TB masks.
      The thing is, one can’t neglect the health and safety of the people working in your hospital. If we feel unsafe stepping into Trauma on a Friday night, we might not do our best work.

      Mh. I’ve gone and spoken about things that are wrong and made myself feel pretty pessimistic. I think there definitely is hope for our public hospitals, but I think it’s going to take a whole lot of people – in national government, provincial governments, municipalities, unions, and the citizens, to really improve things.
      I hope I’ve managed to express my thoughts in a coherent way – thanks for making me think!

  23. do what feels right to you and what makes you happy and fulfilled. As long as you are doing good it doesn’t matter where you are.

    Btw gillandrews why do u admire her more cos she’s a girl? Bit sexist. Girls can’t be courageous and selfless?

    • to cho wan yau: Unfortunately, you are right, it is indeed a bit sexist. But also unfortunately, this is how the current society shapes our minds, and it’s hard to “educate” it out of somebody. In my comment, I have not by any means implied that girls can’t be courageous and selfless. I just expressed my surprise, as while reading an article I heard a male voice in my head. Also, in my entirely and solely personal opinion, it takes a tick more courage from a woman to do what barefootmedstudent is doing, maybe due to different psychology, physic etc.

      • yeah that’s where education comes in, i take it u r a woman too, gill. we women r brainwashed by men, yeah for current society and those who wield power, women in board rooms and at the top still minority, fact, that for us to achieve and do what they do we have to be that tad more courageous, brilliant. We cant just be ourselves we have to be more, more than them otherwise we don’t deserve to get to where we are. That view we really have to challenge.

        I raise my daughter to believe she can be whatever she wants and she can. She is smarter than me and I am not dumb; she just doesn’t believe it. Not many women do. 21st century and not that many has changed, not really. Let’s do our bit, spread the word. Maybe it will be better for the next generation. Equal competition.

  24. I was admitted late on a Friday evening to OR Tambo public hospital with a severe case of Hepatitis A that has been ongoing for 2 months. By the time I reached emergencies some of the doctors told me I would not make the night. Fortunatly I did and here I am. The doctors on duty saved my life. The treatment I received was first class. My folks had me at private hospitals, private doctors and now one was able to tell exactly what was wrong apart from the Hepatitis. Within a few hours of being admitted the doctors found out I had not a lot of blood left and was bleeding internally from a ulcer that developed from not eating and as a result I got 6 pints of blood transfused. I do admit I was very sketchy about going but I felt very safe and looked after by many different doctors, professors and last year medical students. Keep up the good work!

    • to cho wan yau:
      Well, while I completely agree with you on your point (women should same rights men have when it comes to opportunities of education, career, etc.) , it was actually not the point I tried to make. I was talking more about “willing to do something by choice”, and not about “be able to do something”. In my opinion (based on empirical evidence “collected” through life), lots of women just decide not to do it by choice, while nobody’s stopping them: not to be a CEO, not to be an astronaut, and not to go to South Africa to save lives of others while endangering their own. Especially the South Africa thing. I’m sure they need any helping hand there they can get; they would go even for a talking panda if it had a respective qualification. But normally, more men than women decide to do these kinds of things. I bet if one pulls the numbers on these thousands of people who applied to be sent to Mars forever, there would be more men as well. For me, it’s totally understandable for many reasons, and not at all a bad thing. It’s just a different thing, that’s all.

      barefootmedstudent, I think I got you a topic for your next post (in case you’ll get bored with your daily business and won’t know what to write about): What’s the deal with gender discrimination in your field in South Africa?

    • Thank you, Theo, for a wonderful and positive story. I do think that we often forget that lives are saved in these hospitals – and only in these hospitals will you be treated by a professor! I think I should write a follow-up post on my blog, just to highlight that there are good things happening, too. I’m glad you had such a positive experience – and that you’re feeling better!

  25. Gill my point is women are not going for those choices deliberately and consciously because of the way they are brought up; presented and perceived by the media, advertisement, in the mainstream. They don’t know/think they have a choice. They have the ability to go for it and do all those marvellous daring and selfless things men tend to go for but it never occurs to them.

    Not many dare to dream big, go beyond their comfort zone and reach for the stars. You’ll find there are many women out there courageous, selfless risking their lives every day. Just look at that petite Burmese leader who had been on house arrest on years and chose not to even go to her husband’s funeral in Oxford for fear they would not let her back in. Her country and people needed her. She was their voice and she was not going to be silenced not even if it meant depriving her of her freedom, contact with the outside world, her family, friends, even intimdation from ruthless military men. Not many men would have the guts and the grit.

    • > Gill my point is women are not going for those choices deliberately and consciously because of the way they are brought up; presented and perceived by the media, advertisement, in the mainstream. They don’t know/think they have a choice.

      Then I guess we made very different experiences in life and/or live in very different countries. Here in central Europe it’s not at all like this. Here women can be what they want, they know it, they dare, they do it. Our head of state is a woman. I also hear that Swedish women are kicking butt, so that their men’s rights would need to be protected soon :) But I also know about the countries where it is the way you describe. So I guess it depends.

      • I’m a little late in responding to these last few – yes, I’m a girl, and it’s not the first time my blog has been mistaken as written by a male, so no offense taken :)
        I think Cho and you both have good points, and I should definitely write about the gender issue in SA, and especially in healthcare. There is a lot to say, so perhaps I’ll try to get it into a blog post soon, rather than writing a dissertation to you in this comment :)

  26. I’d like to share with you a piece I wrote about a remarkable doctor I met in Sri Lanka a long time ago. Dr Stanley. He was a national treasure, too little of his legacy has survived, and I don’t know enough of his details to expand beyond what I blogged. The post concerns the intersection of a great doctor and a great humanitarian (Carla Grissmann) who went on to accomplish remarkable things in Afghanistan. It is at

    http://karlsdrobnic.wordpress.com/the-doctor-in-the-river-and-carla-cries/

  27. I hate to ask but, which hospital are you doing your training at? The conditions sound awful. I’ve been to government hospitals when I was sick and will admit the equipment is often near the end of its life and some of the staff are horrible but, there always seems to be the necessary gloves or whatever is needed. Maybe I was lucky :(

    Aaah well, one can only hope this changes for the better

    • I think I should mention that you won’t see ALL of these things in one night at the hospital. I’ve been working in this hospital for three years now, so they’re just little things I’ve seen and experienced, kind of “only in South Africa” experiences. So, I’m sorry that it sounds so awful, because it probably comes off a lot worse than you would experience it because (hopefully) you’re not in the hospital every day.
      There are always gloves, but we are asked to use them sparingly “for budget reasons”. Sometimes we have to go borrow from another ward when the matron doesn’t replenish the stock enough, but it’s not that there aren’t enough gloves, there just isn’t enough money.
      So, don’t worry :) I think things are getting better. In my third year, there were never any TB masks available, but now I’m starting to see them around more often. I think things will change for the better – I just hope it is soon.

    • Mostly because our hospital has twelve storeys, with two flights of stairs between each one. My cut-off is the seventh floor, because beyond that I need a shower, and an extra fifteen minutes to be on time.
      Also, though, you can’t transport a patient in a wheelchair or bed to another part of the hospital in any other way but the elevators. So that part is unavoidable.

  28. Hi (from a fellow SA) I have paged through most of the comments and retorts that you have given.. and I actually want to say, as a retired man born in Rhodesia and now a citizen of here (been here for 37 years) you and your colleagues receive far more admiration for the work you do than you think.. I have had to take staff that have worked for me to State Hospitals after an accident and to see the conditions you work under is horrifying to say the least. My Mom, an old age pensioner, fell and cut open her head, we rushed her to the local hospital with blood every and found a full waiting area… a nurse came over and stopped the bleeding and assured us she would be attended to as soon as possible.. no gloves, but with such tenderness and care that I was actually surprised considering she was an African Nurse and Mom obviously White (well white after the blood was cleaned), this gave me great hope for the future of our beautiful country… The Doctor that stitched her up was an Indian and man was I impressed with they way he treated her, even giving me his private cell number should there be any problems and that I could call him day or night…
    I remain in awe of the work you do and hope in the future corruption will get less, that you Angels from Heaven, will receive the equipment and things you need to do your great work.. and let you all get salaries that you deserve… I remain ever grateful to you all and stand in thanks for your heartfelt work you perform, that you do tirelessly and still stand up for our country in your blog… I will continue to follow this blog from here on forward… Thank you.

    • Thank you very much for this lovely comment. I’m really glad you have had good experiences at the hospitals, and I appreciate you sharing the experience with me. There really is hope for the country and the continent. Thank you for stopping by, and best wishes to you.

    • Re: Bulldog’s comment: I’m glad your mother got great treatment. But why is it necessary to mention the doctor’s race? No doubt it’ll take generations to weed out colour consciousness in S. Africa. I guess I’m just lucky to live in Canada where most people don’t give a stuff about race.

      • I can understand why Bulldog mentions race: even though South Africans are doing their best to deal with the legacy of Apartheid, there is still a huge awareness regarding race, even more so in generations born before more or less 1990.

        There can sometimes be antagonism among races (please note I use the term with hesitance, and in the conventional, non-scientific sense) especially among older generations.

        “White” people are also acutely aware of the antagonism that there might be towards them because of our history. I know of a lot of white people who cannot afford medical aid and are very hesitant to make use of public healthcare because they are wary of being treated differently. And so, when they do go to hospital and are treated with dignity by doctors of other races, they are pleasantly surprised. Similarly, I once had an elderly “black” female patient who told me upon discharge, “I never knew white people could be so kind.”
        It broke my heart a little.

        So, it’s not really a racISM, but more an uncomfortable racial awareness – unintentional for most people, and an unpleasant consequence of our long history.

        Kind of like: after a long period of strife and dislike, we’re getting to know each other. And just like teenagers would exclaim with surprise when they realise that a long-time rival is actually a nice person, the South African people are learning about each other too. And we’re not really afraid of race – in fact, racial identity is strong – something that I would argue is important. The challenge is just to keep it positive.

        Hope that makes sense. Of course, I can’t speak for Bulldog, but this is the way that I understand the matter.

      • Thanks Marie, for the explanation about “Bulldog’s” reference to race and for putting it in context for me. I guess, as a journalist, and having been away from SA for close to 40 years, a person’s race in relation to his behaviour is immaterial. Just takes me back to the old days in SA when journalists used to report that a “white” man or a “black” man was killed in a car accident. I regard myself first as a human being – a woman as supposed to a “Coloured woman.” It’s labels that divide rather than unite us as human beings.

      • Well jenniferbgraham I don’t give a stuff about colour, my business is of such that the only colour that I’m concerned about is the colour of the money… I live here and hear horrible stories of reverse racialism… and all I wanted to do was prove that no matter what these poor Doctors of ours go through in our provincial hospitals they are appreciated… and loved for the way they treat our sick souls irrespective of colour… I did not want to get into a slanging match of a racial nature nor did I try to imply anything of such… I live here and have right wingers preaching all sorts of crap and I do my best to prove that it does not exist… and Jennifer don’t judge our beautiful land by what you read and see on TV, this is already a land of colorblindness more so than I have come across in the USA and other places where I have visited… my blog is followed by people from all over the world and nowhere on any post to I make is there ever a mention of colour. so as a man in my 60s don’t accuse me of being colour conscious… it does enflame me when people who don’t know me from a bar of soap judge me…

      • Dear Mr Bulldog. I was in no way judging you. Unfortunately, printed copy doesn’t always translate the mood or spirit in which a comment is made. I was merely making an observation and having been born in colour-conscious S. Africa and influenced and affected by apartheid ideology, (left in 1975) I have to constantly remind myself to see the person first, before I see his/her colour, gender or sexual orientation. That’s the spirit in which my comment was made.

  29. This is so sad that this is reality of healthcare in some countries. I wish every person could have access to safe and affordable healthcare. That patients and employees in this enviornment have my prayers.

    • Hah! That’s funny. And sad because it’s true. We actually just heard that we’ll be getting N95 masks at cost price next year. You know, even though we should be getting them for free… I guess it’s better than selling price.
      Thanks for stopping by!

  30. Great Article. Humorous, thought provoking, enlightenment, and more. Kudos to you for all the hard work you are doing. Resourceful, yes you are.

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  33. Thank you for sharing this! It is sad that your government doesn’t do more to take care of its people. A huge eye opener on the South African medical treatment situation.

    • Thanks for stopping by. To be fair, I think that a big part of the government IS trying, but there are a few people who are preventing the money from reaching its desired endpoint. A few people are causing a whole lot of trouble, in my opinion, basically. Corruption, maladministration, and of course the striking culture.

  34. I used to be a nursing student and I was so passionate about it that I decided I was going to get a candy-stripe job to get the feel of working in a hospital. I dropped the whole because after a short while I found out I can’t stand people, mostly young adults and middle-age people. I don’t know if that was a good reason to jump ship but it “sho hells” felt good.

    • I think it is commendable that you could step away. Many people will force themselves to stay and end up being miserable – after all, people would have been your job, you wouldn’t be able to get away from them. We don’t all love people – there are those who will make you feel guilty about it, but it’s just a fact, I suppose.

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  36. hi ;)
    im a law student at a decent university. what you are doing is great, keep it up.
    you are tougher than i was, i couldnt deal with it, couldnt treat patients properly, couldnt get meds, couldnt get beds. hell couldnt even get sleep lol!!

    it is funny though, especially the “traditional healers”. im not sure foreiners understand how serious these people are about their muti ect. lol

    anway, you gotta nice blog here, keep it up. hopefully you dont take you great attitude over the pond. :)

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